100 Main Medical Associates

Key facts

NPI

1619378239

Entity type

Organization (NPI type 2)

Primary specialty

Internal Medicine Physician 207R00000X

Legal business name

100 MAIN MEDICAL ASSOCIATES

Practice address

100 Main St
Paterson, NJ 07505-1024

Phone

(973) 523-0317

Fax

(973) 684-8590

NPI assigned

Sep 15, 2014

Organization subpart

No

Authorized official

Name

Dr. Lowell Taclob, MD

Title

President

Phone

(973) 523-0317

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 15, 2014.

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410739200000",
    "number": "1619378239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MAIN ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075051024",
            "telephone_number": "973-523-0317",
            "fax_number": "973-684-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAIN ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075051024",
            "telephone_number": "973-523-0317",
            "fax_number": "973-684-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "100 MAIN MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-15",
        "last_updated": "2014-09-15",
        "status": "A",
        "authorized_official_last_name": "TACLOB",
        "authorized_official_first_name": "LOWELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-523-0317",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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